The Operating Room Environment
Anesthesiologists, who spend more time
in operat-ing rooms than any other group of physicians, are responsible for
protecting patients and operating room personnel from a multitude of dangers dur-ing
surgery. Some of these threats are unique to the operating room. As a result,
the anesthesiologist may be responsible for ensuring proper functioning of the
operating room’s medical gases, fire preven-tion and management, environmental
factors (eg, temperature, humidity, ventilation, and noise), and electrical
safety. The role of the anesthesiologist also may include coordination of or
assistance with lay-out and design of surgical suites, including workflow
enhancements.
Patients often think of the operating
room as a safe place where the care given is centered around protecting the
patient. Medical providers such as anesthesia personnel, surgeons, and nurses
are responsible for carrying out several critical tasks at a fast pace. Unless
members of the operating room team look out for one another, errors can occur.
The best way of preventing serious harm to a patient is by creating a culture
of safety. When the safety culture is effectively applied in the operating
room, unsafe acts are stopped before harm occurs.
One tool that fosters the safety culture
is the use of a surgical safety checklist. Such checklists are used prior to
incision on every case and can include components agreed upon by the facility
as crucial. Many surgical checklists are derived from the surgical safety
checklist published by the World Health Orga-nization (WHO). For checklists to
be effective, they must first be used; secondly, all members of the surgi-cal
team should be engaged when the checklist is being used. Checklists are most
effective when performed in an interactive fashion. An example of a
suboptimally executed checklist is one that is read in entirety, after which
the surgeon asks whether everyone agrees. This format makes it difficult to
identify possible problems. A better method is one that elicits a response
after each point; eg, “Does everyone agree this is John Doe?”,followed by “Does
everyone agree we are performing a removal of the left kidney?”, and so forth.
Optimal checklists do not attempt to cover every possibility but rather address
only key components, allowing them to be completed in less than 90 seconds.
Some practitioners argue that checklists
waste too much time; they fail to realize that cutting corners to save time
often leads to problems later, resulting in a net loss of time. If safety
checklists were followed in every case, significant reductions could be seen in
the incidence of surgical complica-tions such as wrong-site surgery, procedures
on the wrong patient, retained foreign objects, and other easily prevented
mistakes. Anesthesia providers are leaders in patient safety initiatives and
should take a proactive role to utilize checklists and other activi-ties that
foster the safety culture.
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